Background: The outcome of interventional pain procedures may be influenced not only by technical and patient-related factors but also by contextual factors arising from the physician–patient interaction. Patient expectations and physician communication have been associated with pain outcomes in experimental and clinical settings, but their relevance in CT-guided interventional pain treatment remains insufficiently understood.

Objectives: This study aimed to investigate the associations between patient expectations, perceived physician competence, physician communication, and treatment success in patients undergoing CT-guided periradicular therapy (PRT) for specific low back pain.

Methods: A prospective observational study was conducted between April 2018 and March 2020. A total of 114 patients underwent 467 CT-guided PRT procedures. Before each intervention, patients rated their current pain intensity, expected treatment success, and perceived competence of the treating physician. During the intervention, an independent observer documented physician–patient communication, including whether the physician expressed confidence in treatment success and whether positive, neutral, or negative wording was used. Treatment success was defined as a reduction of at least 0.5 points on the Visual Analog Score (VAS) between the pre-intervention score of the respective session and the final score obtained after completion of the treatment course. Associations between the investigated contextual factors and treatment success were evaluated using random-effects logistic regression models accounting for clustering at the patient and physician levels.

Results: Treatment success was observed in 255 of 467 interventions (54.6%). Higher perceived physician competence was significantly associated with treatment success (age- and sex-adjusted OR 1.62, 95% CI 1.37–1.93; fully adjusted OR 1.39, 95% CI 1.17–1.67). Physician communication of confidence in treatment success was also associated with improved treatment outcomes (fully adjusted OR 1.84, 95% CI 1.17–2.91). The strongest association was observed for positively framed language during the intervention compared with predominantly negative wording (fully adjusted OR 4.31, 95% CI 2.30–8.07). In contrast, patient expectations were not significantly associated with treatment success after adjustment for the investigated contextual factors (OR 1.05, 95% CI 0.94–1.17).

Conclusions: The findings suggest that physician-related contextual factors may be associated with treatment outcomes in CT-guided PRT. Positive physician communication, expression of confidence in treatment success, and higher perceived physician competence were associated with greater odds of pain reduction, whereas patient expectations showed no significant independent association after full adjustment. Physician–patient communication represents a potentially modifiable factor that may be relevant to pain management. Further prospective interventional studies are warranted to determine whether targeted communication strategies can improve outcomes following interventional pain procedures.

Expectation effect, Physician-patient communication, CT-guided therapy, Low back pain, Periradicular therapy